Peripheral T Lymphocyte Predicts the Prognosis of Gastric Cancer Patients Undergoing Radical Gastrectomy: A Multicenter Retrospective Cohort Study.

OBJECTIVE

The aim of this study was to investigate the predictive value of peripheral lymphocyte subsets for prognosis of gastric cancer (GC) patients following radical gastrectomy.

METHODS

Consecutive GC patients received curative resection and examined peripheral lymphocyte subsets in Hunan Cancer Hospital were enrolled as training cohort (n=231), and those from Wuhan Union Hospital and Wuhan Tongji Hospital were included as external validation cohort (n=159). The optimal cutoff values of lymphocyte subsets for overall survival (OS) in training cohort were determined by X-tile. The independent predictive factors for OS were identified using univariate and multivariate Cox regression analyses. Furthermore, the predictive value of lymphocyte subsets were evaluated in validation cohort.

RESULTS

The optimal cutoff value of T lymphocytes for OS was 0.84×10/L in the training cohort. Decreased T lymphocyte (<0.84×10/L) were identified as an independent predictor for unfavorable prognosis both in the training and validation cohorts (HR:2.835, 95% CI:1.580-5.087, <0.001; HR:2.470, 95% CI:1.069-5.711, =0.034). In the entire cohort, stratified analyses revealed that lower T lymphocyte negatively affected the oncological outcomes in patients with stage II/III disease. A synergistic influence was confirmed in those with decreased T lymphocyte and not received adjuvant chemotherapy (AC). Further analyses revealed that AC significantly prolonged OS in stage II/III patients with decreased T lymphocyte, but not in those with relatively higher T lymphocyte.

CONCLUSION

Peripheral T lymphocyte numbers was a reliable predictor for OS in GC patients undergoing radical gastrectomy. Additionally, T lymphocyte might serve as an indicator for efficacy of AC in stage II/III GC patients.